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糖皮质激素由于是CYP3A4和P-gp的诱导剂与他克莫司(tacrolimus,TAC)存在相互作用.但是,目前研究中的糖皮质激素剂量均为低剂量而非冲击剂量.本研究回顾性的研究63名肾移植术后患者,根据患者服用的糖皮质激素剂量进行分组:500 mg(术后1-3天),30 mg(术后4-10天),25 mg(术后11-17天),20 mg(术后18-24天),15 mg(术后25-31天),10 mg(术后32-60天)和10 mg(术后61-90天).我们每日详细记录患者从手术至术后90天的患者检验和用药信息.研究发现:术后3个月内,不同糖皮质激素剂量下TAC的血药浓度无显著性差异,但是随着糖皮质激素的剂量减低,TAC的平均每日剂量显著性降低.同时,术后1-4天内,TAC每日的剂量没有变化,但是当糖皮质激素的剂量由500 mg减为30 mg时,TAC的浓度显著降低.本研究验证了低剂量的糖皮质激素对TAC的诱导效应,同时发现高剂量糖皮质激素和他克莫司合用时,糖皮质激素可能起到相关作用,为竞争性底物效果.因此在肾移植术后受者的糖皮质激素剂量发生变化时,监测TAC的血药浓度是有必要的.“,”There is an interaction between tacrolimus (TAC) and glucocorticoids where glucocorticoids is a known CYP3A4 and P-gp inducer.However,the dose of glucocorticoids reported is low but not pulse therapy.We retrospectively studied 63 renal transplant recipients receiving TAC after transplantation.All the patients were classified as 500 mg (POD 1-3),30 mg (POD 4-10),25 mg (POD 11-17),20 mg (POD 18-24),15 mg (POD 25-31),10 mg (POD 32-60) and l0 mg (POD 61-90).We recorded daily data for each patient from the day of transplantation until POD 90.There was no difference in TAC blood levels within the 3 months after transplantation in the glucocorticoids groups.However,the average daily dose of TAC was significantly lower by weekly reductions of 5 mg dose.The TAC daily dose was not changed from POD 1-4,but the blood concentrations of TAC were significantly lower after the glucocorticoid dose was changed from 500 mg to 30 mg.We demonstrated the induction effect of low-dose glucocorticoids on TAC in renal transplant recipients,and found that the high-dose of glucocorticoids might play a role in substrate competition.We proposed that monitoring of the blood concentrations of TAC was needed when the glucocorticoid dose was changed in the patient undergoing renal transplantation.